Organization
MARY BLACK PHYSICIANS GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
V KAREN FLINN (VICE PRESIDENT)
(214) 473-3773
Entity
Organization
Contact information
Practice address
724 HYATT ST, STE #F, GAFFNEY, SC 29341-2630
(864) 489-5001
(864) 489-7788
Mailing address
PO BOX 277827, ATLANTA, GA 30384-7827
(864) 253-8080
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4690
—
VA
Enumeration date
07/20/2007
Last updated
07/02/2008
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